Foreign aid funding cuts are reshaping the global health landscape, creating urgent funding gaps and forcing difficult prioritization decisions across health systems worldwide. To understand the real-world effects, it’s essential to hear from the organizations working on the front lines with government partners to navigate the funding crisis. The Clinton Health Access Initiative (CHAI) is a large global health nonprofit and an important GiveWell partner in this work.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with CHAI CEO Dr. Neil Buddy Shah about how the aid cuts are affecting vital health programs and what it takes to build a strategic response. They discuss the hidden complexities of the funding landscape, the difficult choices governments are being forced to make, and what this pivotal moment could mean for the future of global health.

Elie and Buddy discuss:

• The “gap identification” challenge: In many countries, a significant portion of the national health budget comes from foreign aid, and the funding cuts revealed a surprising vulnerability—many national health ministries don’t have a comprehensive map of who funds what within their own systems. The first step needed was a complex data-gathering exercise to identify where the gaps emerged.
• A strategic response to the crisis: CHAI is helping governments implement a three-pronged response. This includes (1) driving efficiencies to make existing funds go further, (2) reprioritizing budgets to protect the most essential services, and (3) advocating for increased domestic health funding.
• The long-term view: While the cuts are already causing significant drops in areas like HIV testing, the most severe health consequences are expected to hit in the coming years. The crisis represents a major shakeup of the funding and delivery system that has defined global health for 20 years, creating a critical opportunity to rethink what should come next.

The conversation reveals both the immediate crisis and long-term transformation occurring in global health. While governments are working to maintain some vital services through improved efficiency and reprioritization, these measures cannot compensate for the scale of funding reductions. GiveWell is working closely with partners like CHAI to understand the complexities of this new funding landscape and direct funding where our research shows it can have the greatest impact.

Visit our Foreign Aid Funding Cuts webpage to learn more about our response and how you can help, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on August 20, 2025 and represents our best understanding at that time.